Our Patients. Their Stories. Heidi Fishman

If what you have isn’t working, speak up. Say what you need. Don’t be afraid.

Heidi Fishman

Heidi Fishman of Norwich, VT, says the headaches came out of the blue. “It felt like an explosion went off behind one eye, and lasted hours,” she recalls.

In summer of 2015, Fishman, a writer, was in the middle of a five-year-long project tracing her grandparents’ and mother’s harrowing experience enduring persecution and escaping death during the rise of Hitler’s Nazi regime. This book, to be titled Tutti’s Promise, demanded much of Fishman’s energy and focus.

When the headaches began, she says, she couldn’t think straight. “I couldn’t work on my book. I couldn’t be a mom. I couldn’t do anything.”

These migraines occurred on a daily basis, each lasting hours, and seemed to be triggered by any increase in Fishman’s heart rate—at the gym, for instance, in the middle of a workout.

But even the smallest activity could set off another one. “It could be as simple as making a cup of coffee and going out on the deck to try to read a book. The flood of light would be too much and I’d have to go lie down,” she says. “I was basically in bed for two months.”

Finally, in August, after a couple of weeks of intense, daily headaches that left her feeling weak, she visited her primary care physician at Alice Peck Day Memorial Hospital, who referred her to the Neurology Department at Dartmouth-Hitchcock Medical Center (DHMC).

Barbara Nye, MD, received Fishman’s case and ordered a magnetic resonance imaging (MRI), the results of which ruled out the presence of brain tumors or evidence of stroke. “Fortunately, they didn’t find any huge, terrible things,” she says, “but they did find that I have a dissected carotid artery.”

Carotid artery dissection occurs when layers of the artery separate and cause a tear in the artery wall, which can cause stenosis and narrow the blood flow, carrying the threat of stroke. While some research suggests a link between carotid artery dissection and migraine, it’s not conclusive.

Nye prescribed a migraine preventative medication that, Fishman says, “took the pain away but made my brain fuzzier.” Fishman spent another several weeks unable to work as the medication put her in a complete fog. So Nye suggested another medication that may be more effective and eliminate the “druggy” side effects. Fishman’s insurance provider initially denied approval of this new medication, but she paid the out-of-pocket fee for a five-day dosage to see if the medication actually worked—and was worth fighting for.

“Immediately,” Fishman says, “I was back. The difference was so clear.”

Determined not to suffer in silence or without a form of pain relief that effectively gave her back her life, Fishman relied on a skill set she believed would help: her writing. She wrote a letter detailing her health situation and the amazing impact of the medication that the insurance provider did not cover and received approval.

Since the migraines began about two years ago, Fishman has learned even more about how to anticipate them. Not getting enough sleep, the stress brought on by “a houseful of teenagers” or changes in the weather are contributors. “Now I check the forecast for swings in the barometric pressure, and I take my medication in anticipation,” she says.

And as a patient she’s learned that, “you have to advocate for yourself. If what you have isn’t working, speak up. Say what you need. Don’t be afraid.”

In March 2017, Fishman published Tutti’s Promise, a book that seeks to educate children on the terrible lessons of history. And now she takes every opportunity she can to visit schools and share her family’s story of hope, courage and survival.